Healthcare Provider Details

I. General information

NPI: 1730240391
Provider Name (Legal Business Name): KATHRYN AGATA RICE MSW LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 OLD PECOS TRAIL SUITE C
SANTA FE NM
87505
US

IV. Provider business mailing address

PO BOX 31535
SANTA FE NM
87594
US

V. Phone/Fax

Practice location:
  • Phone: 505-469-9259
  • Fax:
Mailing address:
  • Phone: 505-438-2004
  • Fax: 505-438-4595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberNMI4097
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: